Selección de Resúmenes
de Menopausia
Julio de 2009
Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile
Semana
del 1al 7 de Julio de 2009
Menopause. 2009 Jul 1. [Epub ahead of print]
Vaginal symptoms in
postmenopausal women: self-reported severity, natural history, and risk
factors.
Huang AJ, Moore EE, Boyko EJ, Scholes D, Lin F, Vittinghoff E, Fihn SD.
From
the 1Department of Medicine,
OBJECTIVE:: This study aimed to examine factors other than estrogen deficiency influencing the development and
persistence of vaginal dryness, itching, and painful sexual intercourse after
menopause. METHODS:: We analyzed data from a 2-year,
population-based cohort of 1,017 postmenopausal women aged 55 to 75 years.
Vaginal symptoms were assessed by interviewer-administered questionnaire, and
vaginal swabs were performed to assess vaginal pH and microbial flora at
baseline, 12 months, and 24 months. Generalized estimating equations were used
to identify characteristics associated with symptoms. RESULTS::
Half of the women (n = 471) reported problematic vaginal dryness, a third (n =
316) reported itching, and 40% of sexually active women (n = 166) reported
painful intercourse at baseline. Of women not taking estrogen,
half of those reporting baseline symptoms were symptomatic after 24 months.
Vaginal dryness was associated with younger age (odds ratio [OR], 0.81; 95% CI,
0.69-0.94, per 5-y increase), nonwhite race (ie, African American, Hispanic, Asian or Pacific Islander,
or American Indian [OR, 1.53; 95% CI, 1.04-2.27]), diabetes (OR, 1.51; 95% CI,
1.07-2.12), lower 36-item Short-Form Health Survey physical functioning scores
(OR, 0.90; 95% CI, 0.85-0.97, per 10-point increase), lower body mass index
(OR, 0.81; 95% CI, 0.71-0.93, per 5 kg/m increase), recent sexual activity (OR,
1.14; 95% CI, 1.08-1.21), and vaginal colonization with enterococci
(OR, 1.25; 95% CI, 1.04-1.51). Vaginal itching was also associated with lower
physical functioning scores (OR, 0.86; 95% CI, 0.80-0.92, per 10-point
increase). Risk factors for painful intercourse included younger age (OR, 0.72;
95% CI, 0.56-0.93, per 5-y increase), diabetes (OR, 3.48; 95% CI, 1.93-6.27),
lower body mass index (OR, 0.76; 95% CI, 0.61-0.95, per 5 kg/m increase), and
higher vaginal pH (OR, 1.10; 95% CI, 1.00-1.21, per 0.5 units). CONCLUSIONS:: Vaginal symptoms affect a large proportion of
postmenopausal women, particularly those with diabetes and those with lower
body mass index, but may resolve for up to half of women without estrogen therapy.
Atherosclerosis. 2009 Jun 6. [Epub ahead of print]
Coronary heart
disease and menopause management: The swinging pendulum of HRT.
Stevenson
JC,
Hodis HN, Pickar JH, Lobo RA.
National Heart
& Lung Institute,
The Women's Health
Initiative comprised a randomized placebo-controlled clinical trial of
therapeutic and dietary interventions influencing postmenopausal women's
health. One arm evaluated hormone replacement therapy and its effects on major
health outcomes. Initial publication of the preliminary results suggested
overall harm from hormone replacement therapy, leading to a dramatic worldwide
decrease in its use, and concerns from clinicians and regulatory authorities.
Subsequent publications with more detailed analyses appear to have
countermanded these initial concerns. Analyses of the studies have not been
adherent to those specified in the original published protocol. Nominal
confidence intervals should have been used only for the primary outcome, which
was coronary heart disease. Initially reported as showing a
significant increase in events with hormone replacement therapy, in a
subsequent analysis of the full data the increase was no longer significant.
Adjusted confidence intervals showed no significant increase for breast cancer,
the primary adverse outcome. A major difference in the effects of hormones
between younger and older women has emerged but this important finding has been
minimized. For women under age 60 years or within 10 years of menopause, the
final findings for all outcomes closely resemble those
from observational cohorts. The raw data must be made available for independent
assessment to obtain valid conclusions which may again change clinical
practice.
J Appl
Physiol. 2009 Jul 2. [Epub ahead of print]
Hormone replacement
therapy attenuates exercise-induced skeletal muscle damage in postmenopausal
women.
Dieli-Conwright CM, Spektor TM, Rice JC, Schroeder
ET.
Hormone
replacement therapy (HRT) is a potential treatment to relieve symptoms of
menopause and prevent the onset of disease such as osteoporosis in
postmenopausal women. We evaluated changes in markers of exercise-induced
skeletal muscle damage and inflammation (serum CK, serum LDH, and mRNA
expression of IL-6, IL-8, IL-15, and TNF-alpha) in postmenopausal women
following a high-intensity resistance exercise bout. Fourteen postmenopausal
women were divided into two groups: Control, women not using HRT (n=6, 59+/-4
yr, 63+/-17 kg), or HRT, women using traditional HRT
(n=8, 59+/-4 yr, 89+/-24 kg). Both groups performed 10 sets of 10 maximal
eccentric repetitions of single-leg extension on the Cybex
dynamometer at 60 degrees /s with 20 second rest periods between sets. Muscle
biopsies of the vastus lateralis
were obtained from the exercised leg at baseline and 4 hours after the exercise
bout. Gene expression was determined using RT-PCR for IL-6, IL-8, IL-15, and
TNF-alpha. Blood draws were performed at baseline and 3 days post-exercise to
measure CK and LDH. Independent t-tests were performed to test group
differences (Control vs HRT). A probability level of
p</=0.05 was used to determine statistical significance. We observed
significantly greater changes in mRNA expression of IL-6, IL-8, IL-15,
TNF-alpha (p</=0.01) in the Control group compared to the HRT group
following the exercise bout. CK and LDH levels were significantly greater
post-exercise (p</=0.01) in the Control group. Postmenopausal women not
using HRT experienced greater muscle damage after maximal eccentric exercise indicating
a possible protective effect of HRT against exercise-induced skeletal muscle
damage.
Neuropsychiatr. 2009;23(2):71-83.
Antipsychotics and hyperpolactinaemia: Pathophysiology,
clinical relevance, diagnosis and therapy.
Riecher-Rössler
A,
Schmid C, Bleuer S, Birkhäuser M. Psychiatrische Poliklinik, Universitätsspital
Basel.
Hyperprolactinaemia is a
frequent but often neglected side effect of typical, but also of many atypical
antipsychotics such as amisulpiride, risperidone or ziprasidone.
Besides galactorrhoea, potential consequences are
suppression of the hypothalamic-pituitary-gonadal
axis with hypogonadism, sexual dysfunction,
infertility and in women also irregularities of the menstrual cycle and
amenorrhoea. Potential long term consequences are mainly osteopenia
and osteoporosis with an enhanced risk of fractures. Hyperprolactinaemia,
if not clearly caused by a prolactin inducing
antipsychotic, should always be thoroughly investigated. Ideally, prolactin should be measured before starting a patient on a
new antipsychotic. Furthermore, before neuroleptic
treatment is begun, and also in regular intervals after that, patients should
be asked about potential clinical signs of hyperprolactinaemia.
Hyperprolactinaemia which is clearly due to
antipsychotics but without clinical symptoms only requires regular controls of
bone mineral density. However, if clinical symptoms occur, switching to a prolactin sparing antipsychotic may be necessary. In these
cases fertility is often regained and the women concerned have to be informed
about the enhanced risk of pregnancy and counselled regarding contraception. If
switching is not possible, estradiol has to be
substituted in women. Also in men with hypogonadism hormonesubstitution (with testosterone) is usually
indicated. Hyperprolactinaemia
in psychiatric patients should be taken more seriously in the future.
Int J Cancer. 2009 Jun 30. [Epub ahead of print]
The association of plasma
androgen levels with breast, ovarian, and endometrial cancer risk factors among
postmenopausal women.
Danforth KN, Eliassen AH, Tworoger SS, Missmer SA, Barbieri RL, Rosner BA, Colditz GA, Hankinson
SE
Channing
Laboratory, Department of Medicine,
Although androgens
may play an etiologic role in breast, ovarian, and endometrial cancers, little
is known about factors that influence circulating androgen levels. We conducted
a cross-sectional analysis among 646 postmenopausal women in the Nurses' Health
Study to examine associations between adult risk factors for cancer, including
the Rosner/Colditz breast
cancer risk score, and plasma levels of testosterone, free testosterone, androstenedione, dehydroepiandrosterone
(DHEA), and DHEA sulfate (DHEAS). All analyses were
adjusted for age, laboratory batch, and other cancer risk factors. Free
testosterone levels were 79% higher among women with a BMI of >/=30 vs.
<22 kg/m(2) (p-trend<0.01) and 25% higher among
women with a waist circumference of >89 vs. </=74 cm (p-trend=0.02).
Consuming >30 grams of alcohol a day vs. none was associated with a 31%
increase in DHEA and 59% increase in DHEAS levels (p-trend=0.01 and <0.01,
respectively). Smokers of >/=25 cigarettes per day had 35% higher androstenedione and 44% higher testosterone levels than
never smokers (p-value, F-test=0.03 and 0.01, respectively). No significant
associations were observed for height or time since menopause with any
androgen. Testosterone and free testosterone levels were approximately 30%
lower among women with a hysterectomy vs. without (both p-values<0.01).
Overall breast cancer risk was not associated with any of the androgens. Thus,
several risk factors, including body size, alcohol intake, smoking, and
hysterectomy, were related to androgen levels among postmenopausal women, while
others, including height and time since menopause, were not. Future studies are
needed to clarify further which lifestyle factors modulate androgen levels.
Osteoporos Int. 2009 Jul
2. [Epub ahead of print]
Bisphosphonates and osteoporotic
fractures: a cross-design synthesis of results among compliant/persistent
postmenopausal women in clinical practice versus randomized controlled trials.
Wilkes MM, Navickis RJ, Chan WW, Lewiecki EM.
Hygeia
Associates,
INTRODUCTION: The
purpose of the study was to determine whether clinical fracture risk reduction
by bisphosphonate treatment in women with
postmenopausal osteoporosis differs between randomized controlled trials and
routine practice. METHODS: Randomized trials comparing bisphosphonate
with placebo and observational studies comparing highly compliant/persistent
with less compliant/persistent patients were sought by electronic searches and
ancillary methods. Clinical fracture data were extracted from the study reports
and quantitatively combined by random effects metaanalysis.
RESULTS: The odds ratio (OR) for all clinical fractures in randomized trials of
0.762, with a 95% confidence interval (CI) of 0.680-0.855, was closely similar
to that in the observational studies (OR, 0.797; CI, 0.748-0.850). Pooled
clinical fracture reduction across both study designs was 22%. Nonvertebral, vertebral, and hip fractures were also
significantly reduced by bisphosphonate treatment in
both randomized trials and observational studies. CONCLUSIONS:
Compliant/persistent patients in the "real-world" setting benefit
from bisphosphonate treatment to a similar extent as
patients in randomized trials.
Maturitas. 2009 Jun 29. [Epub ahead of print]
Lifetime
endogenous estrogen exposure and electrocardiographic
frontal T axis changes in postmenopausal women.
Atsma F, van der Schouw YT, Grobbee DE, Kors JA, Bartelink ML.
Objetive: The
protective effect of endogenous estrogens in cardiovascular disease may in part
originate from effects of circulating estrogens on the electrophysiological
properties of the myocardium. The aim of this study was to investigate the
relation between reproductive factors and the electrocardiographic frontal T
axis in postmenopausal women. Design: Cohort study. SETTING: The study was
conducted at the University Medical Center Utrecht.
Patients: In total, 998 postmenopausal women were included. Main outcomes:
Information of women's reproductive life was obtained by a questionnaire.
Electrocardiographic frontal T axes were categorized as normal (25-65 degrees ) or abnormal (-180 degrees to 24 degrees and 66-180
degrees ). Logistic regression analysis was used to assess the relationship
between reproductive factors and the frontal T axis. Moreover, the effect of
the lifetime cumulative number of menstrual cycles, a composite measure of all
reproductive factors, on the frontal T axis was investigated. Results: The mean
age was 66.0 (+/-5.6) years and 15.3% had T-axes abnormalities. Later
menopausal age decreased the risk on frontal T-axis abnormalities; the
multivariable adjusted odds ratio was 0.97 (95% CI: 0.94-0.99) per year
increasing menopause. For the lifetime cumulative number of menstrual cycles
the age-adjusted odds ratio was 0.84 (95% CI: 0.75-0.99) per 100 menstrual
cycles increase. Conclusions: Later age at menopause and increasing lifetime
cumulative number of menstrual cycles decreased the risk on frontal T-axis
changes. This supports the view that estrogens may protect against ventricular repolarization disturbances
J Clin Endocrinol Metab. 2009 Jun 30. [Epub ahead of print]
Effect of once-yearly
zoledronic acid 5 mg on fracture risk and change in
femoral neck bone mineral density.
Eastell R, Black DM, Boonen S, Adami S, Felsenberg D, Lippuner K, Cummings
SR, Delmas PD, Palermo L, Mesenbrink P, Cauley JA; for the
HORIZON Pivotal Fracture Trial.
Academic
Unit of Bone Metabolism,
Context: In the
Health Outcomes and Reduced Incidence with Zoledronic
Acid Once Yearly - Pivotal Fracture Trial (HORIZON-PFT), zoledronic
acid (ZOL) 5 mg significantly reduced fracture risk. Objective: To identify
factors associated with greater efficacy during ZOL 5 mg treatment. Design, Setting and Patients: Subgroup analysis (preplanned
and post hoc) of a multicenter, double-blind, placebo-controlled, 36-month
trial in 7765 women with postmenopausal osteoporosis. Intervention: Single
infusion of ZOL 5 mg or placebo at baseline, 12 and 24 months. Main Outcome
Measures: Primary endpoints: new vertebral fracture and hip fracture. Secondary
endpoints: non-vertebral fracture, change in femoral neck bone mineral density
(BMD). Baseline risk factor subgroups: age, BMD T-score and vertebral fracture
status, total hip BMD, race, weight, geographical region, smoking, height loss,
history of falls, physical activity, prior bisphosphonates,
creatinine clearance, body mass index (BMI),
concomitant osteoporosis medications. Results: Greater ZOL induced effects on
vertebral fracture risk with younger age (treatment-by-subgroup interaction
P=0.05), normal creatinine clearance (P=0.04), and
BMI >/=25 kg/m(2) (P=0.02). There were no
significant treatment-factor interactions for hip or non-vertebral fracture or
for change in BMD. Conclusions: ZOL appeared more effective in preventing
vertebral fracture in younger women, overweight/obese women and women with
normal renal function. ZOL had similar effects irrespective of fracture risk
factors or femoral neck BMD.
J
Thromb Haemost. 2009 Jun 30. [Epub ahead of print]
Smoking and venous thromboembolism: a Danish follow-up study.
Severinsen MT, Kristensen SR, Johnsen SP, Dethlefsen C, Tjřnneland A, Overvad K.
Department
of Clinical Epidemiology,
Summary
Background: Large-scale prospective studies are needed to assess whether
smoking is associated with venous thromboembolism
(VTE), i.e. deep venous thrombosis and pulmonary embolism, independently of
established risk factors. Objective: To investigate the association between
smoking and the risk of VTE among middle-aged men and women. Methods: From 1993
to 1997, 27,178 men and 29,875 women, aged 50 to 64 year and born in
Gynecol Endocrinol. 2009 Jun 26:1-5. [Epub ahead of
print]
Testosterone addition
to estrogen therapy - Effects on inflammatory markers
for cardiovascular disease.
Kocoska-Maras L, Linden
Hirschberg A, Bystrom B, Schoultz BV, Rĺdestad AF.
Karolinska Institutet and
Objective. To
analyze the effects of testosterone addition to estrogen
therapy in comparison with estrogen alone on
cardiovascular risk factors in postmenopausal women. Methods.
Fifty surgically postmenopausal women were included in this double-blind,
placebo-controlled and randomized study to receive daily oral treatment with estradiol valerate 2 mg + placebo
(E/P) or estradiol valerate
2 mg + testosterone undecanoate 40 mg (E/T) for 24
weeks and then switched to the other regimen for another 24 weeks. Sex
hormones, High sensitivity CRP (hsCRP), Interleukin-6
(IL-6), Tissue necrosis factor (TNF)-alpha, Insulin-like growth factor binding
globulin (IGFBP-1), vascular cell adhesion molecule (VCAM)- 1, and homocysteine were analyzed at baseline and after 6 and 12
months. Results. Estradiol
and androgens increased as expected during the treatments. After 6 months of
E/P, increases of hsCRP and IGFBP-1 and a decline of
VCAM were recorded, whereas IL-6, TNF-alpha, and homocysteine
were unchanged. When testosterone was added to estrogen,
the increase of IGFBP-1 and decline in VCAM was similar as with estrogen treatment alone. However, testosterone addition
counteracted the estrogen-induced rise in hsCRP but had no effects on IL-6, TNF-alpha, and homocysteine. Conclusion. Data
suggest that testosterone addition to estrogen
treatment in postmenopausal women has a modest influence on inflammatory
markers and there were no apparent adverse effects. On the contrary, the estrogen-induced increase in hsCRP
was suppressed.
Semana
del 8 al 14 de Julio de 2009
Climacteric. 2009 Jul 7:1-12. [Epub
ahead of print]
Dose effects of
oral estradiol on bone mineral density in Japanese
women with osteoporosis.
Mizunuma H, Taketani Y, Ohta H, Honjo H, Gorai I, Itabashi A, Shiraki M.
Department of Obstetrics and Gynecology,
Objectives
This 2-year study compared 0.5 and 1.0 mg oral estradiol
(E(2)), with or without levonorgestrel
(LNG), for the treatment of postmenopausal osteoporosis in Japanese women.
Methods Japanese women with osteoporosis after natural menopause or bilateral oophorectomy were randomized to receive E(2)
0.5 or 1.0 mg/day with LNG 40 mug as required, or placebo, for 52 weeks. Women
treated with E(2) in the first year continued therapy
at the same doses in the second year. Efficacy, safety and pharmacokinetics
were assessed. Results There were 73 women randomized to E(2)
0.5 mg, 157 to E(2) 1.0 mg and 79 to placebo. Lumbar bone mineral density at 52
weeks increased significantly more with E(2) 1.0 mg (p
< 0.001) and 0.5 mg (p < 0.001) than with placebo (no change). After 2
years, a 10% increase in bone mineral density with E(2)
1.0 mg was significantly greater than with E(2) 0.5 mg (8%; p = 0.008]. E(2) was associated with an acceptable safety and
tolerability profile, with slightly more adverse events with E(2) 1.0 than 0.5
mg. Serum E(2) concentration increased in a dose-dependent manner. Conclusion
This study showed that E(2), at both 1.0 mg and 0.5 mg doses, was effective in
increasing bone mineral density with an acceptable safety and tolerability
profile in Japanese postmenopausal women with osteoporosis but that the bone
mineral density response was higher with the 1.0 mg dose.
Climacteric. 2009 Jul 8:1-8. [Epub
ahead of print]
Effect of non-oral estrogen on risk markers for metabolic syndrome in early
surgically menopausal women.
Kilic S, Yilmaz N, Erdogan G, Aydin M, Tasdemir N, Doganay M, Batioglu S.
Department of Reproductive Endocrinology, Zekai
Tahir Burak Women's
Objective
Postmenopausal women are at an increased risk of cardiovascular disease and
metabolic syndrome as many risk factors are aggravated by menopause. Elevated
levels of homocysteine, triglyceride and asymmetric dimethylarginine (ADMA) have been recognized as risk
factors for metabolic syndrome. The present study aimed to investigate the
effect of transdermal estrogen
treatment on serum levels of atherogenic amino acids,
homocysteine, triglyceride, high density lipoprotein
(HDL) cholesterol and ADMA in women with surgical menopause. Methods A
prospective study was conducted in 85 surgically menopausal Turkish women at
the Department of Menopause of Dr Zekai Tahir Burak Women's Health
Research and Education Hospital between March 2007 and March 2008. Subjects
were divided into two groups: a treatment group (Group 1) and control (Group
2). Group 1 (n = 46) received transdermal estrogen while Group 2 (n = 39) received no treatment. Body
mass index (BMI) and levels of serum homocysteine,
ADMA, triglyceride and HDL cholesterol were analyzed postoperatively at the
first visit (baseline) and 6th months. Results The two groups did not differ in
age, baseline BMI and levels of ADMA, homocysteine
and triglyceride. In Group 1, values of serum ADMA, homocysteine,
triglyceride and HDL cholesterol levels were not different at baseline and at the
6-month visit (p = 0.996, p = 0.564, p = 0.113 and p = 0.173, respectively). On
the other hand, the baseline and the 6th month measurements of serum ADMA, homocysteine and HDL cholesterol levels were significantly
different in Group 2 (p = 0.001, p = 0.001, and p = 0.023, respectively).
Conclusion Transdermal estrogen
treatment has a protective effect against the risk factors of metabolic
syndrome (homocysteine, ADMA, HDL cholesterol) in
surgically menopausal patients who have undergone surgery in the early
premenopausal period.
Curr Opin Oncol. 2009
Jul 7. [Epub ahead of print]
Managing menopausal
symptoms after gynecological cancer.
Gynecology,
PURPOSE
OF REVIEW: As the length of survival in patients with gynecological
malignancies increases due to advances in early diagnosis and therapy, quality
of life becomes a major issue for the survivors. These women frequently suffer
symptoms following an iatrogenically induced
menopause. Many gynecologists advise these patients
against hormonal replacement therapy. This review attempts to provide the
clinician with information based on current evidence. RECENT FINDINGS: The most
recent two prospective studies did not find an increase in the recurrence rates
in endometrial cancer patients who used hormonal replacement therapy. To date,
there are few studies on hormonal replacement therapy in patients with ovarian
cancer but the available data suggest that there is no detriment to overall or
disease-free survival. There are no data showing an association between poorer
outcome and hormonal replacement therapy use in patients with cervical or vulvar cancers. SUMMARY: There is no evidence showing
hormones negatively influence survival after treatment for epithelial ovarian, squamous cervical or vulvar
cancer. Their use can be considered in symptomatic patients with endometrial
cancer, after weighing the benefits against the risk of recurrence. Gynecologic cancer survivors suffering from menopausal
symptoms should be supported by advice about the alternatives to hormonal
replacement therapy and by giving them nonbiased information on the present
knowledge on the effects of hormonal use in women with a previous cancer. It is
reasonable to prescribe hormonal replacement therapy to symptomatic, well
informed patients.
Bull NYU
Hosp Jt Dis. 2009;67(2):226-9.
What Can We Learn from Design Faults in the
Women's Health Initiative Randomized Clinical Trial?
Design
faults resulted in the inability of the Women's Health Initiative (WHI)
randomized clinical trial to test the level of cardioprotection
conferred by timely hormone treatment of women seeking help for menopausal
complaints. Adopting a design constructed around the avoidance of symptomatic
subjects and recruitment of older subjects who were more likely to manifest
cardiovascular events during the life of the WHI resulted in recruitment of
older, sicker subjects than are normally treated for complaints around the time
of menopause. The lack of cardioprotection in
subjects that began treatment a decade or more after menopause diluted ardioprotection in subjects starting treatment close to the
menopausal transition. As a result, despite having the largest number of
subjects ever, there were not enough women in the WHI who were comparable to
those in the observational trials that showed cardioprotection.
This led the WHI to report that there was no cardioprotection
in the trial, a position that has been qualifed after
further analysis. Misapprehension of the initial WHI conclusions by the media,
professionals, and regulatory agencies led to a major shift away from
menopausal hormone treatment. This remains problematic since the evidence
continues to favor cardioprotection
and other benefts that are denied under present
regulations and guidelines. Regulatory agencies and professional organizations
need to better understand the faws in the WHI design
and results in order to properly consider its results and the sustainability of
their earlier conclusions and recommendations. Additionally, new trials are
needed to test the validity of menopausal hormone-related cardioprotection.
J Bone Miner
Res.
2009 Jul 6. [Epub
ahead of print]
Mineralization Density Distribution of
Postmenopausal Osteoporotic Bone is Restored to
Roschger P, Lombardi A, Misof BM, Maier G, Fratzl-Zelman N, Fratzl P, Klaushofer K.
Abstract
Long term treatment studies showed that the therapeutic effects of alendronate (ALN) were sustained over a 10 years treatment
period. However, data on the effects on intrinsic bone material properties by
long term reduction of bone turnover are still sparse. We analyzed transiliacal bone biopsies of a subgroup of 30
FLEX-participants (n=6 were treated 10 years with ALN at dose of 10mg/day, n=10
10 years with ALN at dose of 5mg/day and n=14 were treated 5 years with ALN
plus further 5 years with placebo) by quantitative backscattered electron
imaging (qBEI) and scanning small angle X-ray
scattering (sSAXS) to determine the bone
mineralization density distribution (BMDD) and the mineral particle thickness
parameter T. BMDD data from these FLEX-participants were compared to those from
a previously published healthy population (n=52). Compared to 5 years ALN plus
5 years placebo 10 years ALN treatment (independent of the dose given) did not
cause any difference in any of the BMDD-parameters: The weighted mean
(Ca(Mean)), the typical calcium concentration (Ca(Peak)), the heterogeneity of
mineralization (Ca(Width)), the percentage of low mineralized bone areas
(Ca(Low)) and the portion of highly mineralized areas (Ca(High)) were not
different for the patients who continued ALN from those who stopped ALN after 5
years. Moreover, no significant differences for any of the BMDD-parameters
between the FLEX-participants and the healthy population could be observed. In
none of the investigated cases, abnormally high mineralization or changes in
mineral particle thickness were observed (Ca(High) and
T were both in the normal range). The findings of the present study support the
recommendation that antiresorptive treatment with ALN
should be maintained for 5 years. But even at longer treatment duration of up
to 10 years no negative effects on the bone matrix mineralization were
observed.
Rev Bras Ginecol Obstet. 2009 Apr;31(4):196-202.
Quality of life in postmenopausal women, users
and non-users of hormone therapy
Martins MA, Nahas EA, Nahas-Neto J, Uemura G, Buttros Dde
A, Traiman P.
Programa
de Pós-graduaçăo em Ginecologia, Obstetrícia e Mastologia da Faculdade de Medicina de Botucatu da
Universidade Estadual Paulista Júlio de Mesquita Filho - Botucatu (SP), Brasil.
PURPOSE:
to evaluate the quality of life of post-menopause women, users and non-users of
hormonal therapy (HT), in a Healthcare Unit in Franca, Săo Paulo, Brazil.
METHODS: a clinical transversal study, carried out with 250 post-menopausal
women, with ages from 45 to 70 years old, attended to in Healthcare Units, from
September 2007 to August 2008. Participants were divided into two groups: HT
users (n=70) and non-users (n=180). Women making continuous HT use for at least
six months were considered as users. Sociodemographic
and clinical characteristics have been evaluated. Blatt-Kupperman's
menopausal index has been applied to assess climacteric symptoms, and the
Women's Health Questionnaire (WHQ), to assess their quality of life. Fisher's
exact test or chi2 and Mann-Whitney and Kruskal-Wallis's
tests have been used for the statistical analysis. RESULTS: no significant
difference has been found in the comparison of groups, concerning age,
menarche, menopause, parity and body mass index. It has been seen that 67.2% of
the women were married, 83.2% had attended primary school and 53.2% were
housewives, with no difference between the groups. HT users reported lower
frequency of climacteric symptoms (BKMI) with moderate and marked intensity, as
compared to non-users (p<0.001). Even though HT users presented lower
average score in cognitive deficit (p<0.001), vasomotor symptoms (p=0.04),
sleeping problems (p<0.001), attractiveness (p=0.02) from the WHQ, there has
been no difference in the total score, as compared to non-users. CONCLUSIONS:
post-menopausal women, HT users and non-users, admitted at Healthcare Units,
have not presented differences in global quality of life.
Am J Cardiol. 2009 Jul 1;104(1):122-4. Epub 2009 May 4
Osteoporosis
treatment and progression of aortic stenosis.
Skolnick AH, Osranek M, Formica P, Kronzon I.
A
decrease in bone mineral density has been reported to be associated with
increased progression of aortic stenosis (AS). We
hypothesized that osteoporosis treatment (OT) is associated with decreased
progression of AS. We performed an observational study of patients with AS from
our echocardiographic database comparing 18 patients
on OT (bisphosphonates, calcitonin,
or estrogen receptor modulators) with 37 patients not
on OT. All patients had serial echocardiograms. Patients with mitral stenosis, aortic valve replacement, renal failure, calcium
disorders, or left ventricular ejection fraction <40% were excluded. Aortic
valve area (AVA) was calculated using the continuity equation. There was no
significant difference in age, gender, renal function, hypertension, statin use, diabetes, or calcium level between the 2
groups. Mean baseline AVA was 1.33 cm(2) and not
significantly different between groups. After a mean of 2.4 +/- 1.0 years, mean
annual changes in AVA were -0.22 +/- 0.22 cm(2) in those not on OT and -0.10
+/- 0.18 cm(2) in patients receiving OT (p = 0.025). There was a graded
association between AS progression rate and OT. In a multivariable analysis
including age, gender, and statin use, only OT was
associated with a change in AVA. In conclusion, OT is strongly and
independently associated with decreased progression of AS. This association warrants investigation in
a larger, prospective study.
Semana del 15 al 21 de Julio de 2009
Menopause. 2009 Jul 15.
Safety and efficacy
of black cohosh and red clover for the management of
vasomotor symptoms: a randomized controlled trial.
Geller SE, Shulman LP, van Breemen RB, Banuvar S, Zhou Y, Epstein G, Hedayat S, Nikolic D, Krause EC, Piersen CE, Bolton JL, Pauli GF, Farnsworth
NR.
From the
1Department of Obstetrics and Gynecology, Center for Research on Women and Gender, College of
Medicine, University of Illinois at Chicago, Chicago, IL; 2Department of
Obstetrics and Gynecology, Northwestern
University Feinberg School of Medicine, Chicago, IL; 3University of Illinois at
Chicago/National Institutes of Health Center for
Botanical Dietary Supplements Research, College of Pharmacy, University of
Illinois at Chicago, Chicago, IL; and 4Department of Mathematics, Statistics
and Computer Science, University of Illinois at Chicago, Chicago, IL.
OBJECTIVE:: The aim of this study was to evaluate the safety and
efficacy of black cohosh and red clover compared with
placebo for the relief of menopausal vasomotor symptoms. METHODS:: This study
was a randomized, four-arm, double-blind clinical trial of standardized black cohosh, red clover, placebo, and 0.625 mg conjugated equine
estrogens plus 2.5 mg medroxyprogesterone acetate
(CEE/MPA; n = 89). Primary outcome measures were reduction in vasomotor
symptoms (hot flashes and night sweats) by black cohosh
and red clover compared with placebo; secondary outcomes included safety
evaluation, reduction of somatic symptoms, relief of sexual dysfunction, and
overall improvement in quality of life. RESULTS::
Reductions in number of vasomotor symptoms after a 12-month intervention were
as follows: black cohosh (34%), red clover (57%),
placebo (63%), and CEE/MPA (94%), with only CEE/MPA differing significantly
from placebo. Black cohosh and red clover did not
significantly reduce the frequency of vasomotor symptoms as compared with
placebo. Secondary measures indicated that both botanicals were safe as
administered. In general, there were no improvements in other menopausal symptoms.
CONCLUSIONS:: Compared with placebo, black cohosh and red clover did not reduce the number of
vasomotor symptoms. Safety monitoring indicated that chemically and
biologically standardized extracts of black cohosh
and red clover were safe during daily administration for 12 months.
Clin Pharmacol
Ther. 2009 Jul 15. [Epub ahead of print]
No Evidence for
Variation in Colorectal Cancer Risk Associated With Different Types of
Postmenopausal Hormone Therapy.
Hoffmeister M, Raum E, Krtschil A, Chang-Claude J, Brenner H.
Division
of Clinical Epidemiology and Aging Research,
Little is known
about the effects of various types, modes, and routes of hormone replacement
therapy (HRT) on the risk of colorectal cancer (CRC) among postmenopausal
women. We conducted a population-based case-control study with validation of
self-reported hormone use and no upper age limit. In 1,456 postmenopausal women
aged 45-94 years (546 cases, 910 controls), the use of HRT was associated with
reduction in CRC risk among ever users (adjusted odds ratio (OR) 0.65, 95%
confidence interval 0.50-0.84), current users, and recent users. There was no
evidence that risk reduction among current users varies by age. Risk reduction
was seen both in estrogen-only therapy (0.42,
0.23-0.78) and in combination therapy (0.60, 0.41-0.87), the latter regardless
of the mode of therapy, whether with hormone patches (0.40, 0.17-0.90) or with
oral tablets (0.59, 0.39-0.90). In combination with estrogen,
progestagens of the norethisterone
and levonorgestrel families were associated with
strong reduction in CRC risk.
Menopause. 2009 Jul 13. [Epub ahead of print]
Biochemical
markers for cardiovascular disease in recently postmenopausal women with or
without hot flashes.
Tuomikoski P, Mikkola TS, Hämäläinen E, Tikkanen MJ, Turpeinen U, Ylikorkala O.
From
the Departments of 1Obstetrics and Gynecology,
2Clinical Chemistry, and 3Medicine,
OBJECTIVE:: Menopausal hot flashes may affect vascular function and
perhaps explain conflicting data on cardiovascular disease (CVD) between
observational and randomized hormone therapy (HT) studies. We prospectively
assessed hot flash status in recently postmenopausal women and related it to a
number of biochemical vascular surrogate markers for CVD. METHODS:: Healthy, nonsmoking women (n = 150) exhibiting a broad range (no,
mild, moderate, severe) of hot flashes and an onset of menopause within the
previous 0.5 to 3 years were studied with laboratory tests for lipids,
lipoproteins, apolipoproteins, high-sensitivity
C-reactive protein, and sex hormone-binding globulin. RESULTS::
Apart from marked differences in hot flashes, the groups showed comparable
levels of estrone, estradiol,
or free estradiol index. The levels of total
cholesterol (3.7-9.1 mmol/L) were similar between the
groups (P = 0.744), and hypercholesterolemia (>6.5 mmol/L)
was encountered equally often (P = 0.699). No difference was seen in high-,
low-, or very low-density lipoproteins, triglycerides, apolipoprotein
A-1, apolipoprotein B (or their ratio), or lipoprotein(a) between the groups. The levels of sex
hormone-binding globulin and high-sensitivity C-reactive protein correlated
negatively with each other (r = -0.204; P = 0.013) but showed no dependence on
hot flashes (P = 0.531 and P = 0.215, respectively). CONCLUSIONS:: No baseline
difference in lipid or nonlipid CVD risk factors was
observed between women with hot flashes (potential HT users) and women with no
or mild hot flashes (potential HT nonusers). This may imply that hot flash
status per se cannot explain the difference between observational and
randomized trials.
JAMA. 2009 Jul
15;302(3):298-305.
Hormone
therapy and ovarian cancer.
Mřrch LS, Lřkkegaard E, Andreasen AH, Krüger-Kjaer S, Lidegaard O.
Gynaecological Clinic, Rigshospitalet,
CONTEXT: Studies
have suggested an increased risk of ovarian cancer among women taking
postmenopausal hormone therapy. Data are sparse on the differential effects of
formulations, regimens, and routes of administration. OBJECTIVE: To assess risk
of ovarian cancer in perimenopausal and
postmenopausal women receiving different hormone therapies. DESIGN AND SETTING:
Nationwide prospective cohort study including all Danish women aged 50 through
79 years from 1995 through 2005 through individual linkage to Danish national
registers. Redeemed prescription data from the National Register of Medicinal
Product Statistics provided individually updated exposure information. The
National Cancer Register and Pathology Register provided ovarian cancer
incidence data. Information on confounding factors and effect modifiers was
from other national registers. Poisson regression analyses with 5-year age
bands included hormone exposures as time-dependent covariates. PARTICIPANTS: A
total of 909,946 women without hormone-sensitive cancer or bilateral oophorectomy. MAIN OUTCOME MEASURE: Ovarian cancer.
RESULTS: In an average of 8.0 years of follow-up (7.3 million women-years),
3068 incident ovarian cancers, of which 2681 were epithelial cancers, were
detected. Compared with women who never took hormone therapy, current users of
hormones had incidence rate ratios for all ovarian cancers of 1.38 (95%
confidence interval [CI], 1.26-1.51) and 1.44 (95% CI, 1.30-1.58) for
epithelial ovarian cancer. The risk declined with years since last use: 0 to 2
years, 1.22 (95% CI, 1.02-1.46); more than 2 to 4 years, 0.98 (95% CI,
0.75-1.28); more than 4 to 6 years, 0.72 (95% CI, 0.50-1.05), and more than 6
years, 0.63 (95% CI, 0.41-0.96). For current users the risk of ovarian cancer
did not differ significantly with different hormone therapies or duration of
use. The incidence rates in current and never users of hormones were 0.52 and
0.40 per 1000 years, respectively, ie, an absolute
risk increase of 0.12 (95% CI, 0.01-0.17) per 1000 years. This approximates 1
extra ovarian cancer for roughly 8300 women taking hormone therapy each year.
CONCLUSION: Regardless of the duration of use, the formulation, estrogen dose, regimen, progestin type, and route of
administration, hormone therapy was associated with an increased risk of
ovarian cancer.
Breast Cancer Res Treat. 2009 Jul 14. [Epub
ahead of print]
Oral contraceptives
and postmenopausal hormones and risk of contralateral
breast cancer among BRCA1 and BRCA2 mutation carriers and noncarriers:
the WECARE Study.
Figueiredo JC, Haile RW, Bernstein
L, Malone KE, Largent J, Langholz B, Lynch CF, Bertelsen L, Capanu M, Concannon P, Borg A, Břrresen-Dale AL, Diep A, Teraoka S, Torngren T, Xue S, Bernstein
JL.
Department of
Preventive Medicine, Keck School of Medicine, University of Southern
California, Harlyne J Norris Cancer Research Tower,
1450 Biggy Street, Los Angeles, CA, 90033, USA,
janefigu@usc.edu.
The potential
effects of oral contraceptive (OC) and postmenopausal hormone (PMH) use are not
well understood among BRCA1 or BRCA2 (BRCA1/2) deleterious mutation carriers
with a history of breast cancer. We investigated the association between OC and
PMH use and risk of contralateral breast cancer (CBC)
in the WECARE (Women's Environment, Cancer, and Radiation Epidemiology) Study.
The WECARE Study is a population-based case-control study of 705 women with
asynchronous CBC and 1,398 women with unilateral breast cancer, including 181
BRCA1/2 mutation carriers. Risk-factor information was assessed by telephone
interview. Mutation status was measured using denaturing high-performance
liquid chromatography followed by direct sequencing in all participants.
Outcomes, treatment, and tumor characteristics were
abstracted from medical records. Ever use of OCs was not associated with risk
among noncarriers (RR = 0.87; 95% CI = 0.66-1.15) or
BRCA2 carriers (RR = 0.82; 95% CI = 0.21-3.13). BRCA1 carriers who used OCs had
a nonsignificant greater risk than nonusers (RR =
2.38; 95% CI = 0.72-7.83). Total duration of OC use and at least 5 years of use
before age 30 were associated with a nonsignificant
increased risk among mutation carriers but not among noncarriers.
Few women had ever used PMH and we found no significant associations between
lifetime use and CBC risk among carriers and noncarriers.
In conclusion, the association between OC/PMH use and risk of CBC does not
differ significantly between carriers and noncarriers;
however, because carriers have a higher baseline risk of second primaries, even
a potential small increase in risk as a result of OC use may be clinically
relevant.
Menopause. 2009 Jul 8. [Epub ahead of print]
Menopausal symptoms
among breast cancer patients 6 months after diagnosis: a report from the
Dorjgochoo T, Gu K, Kallianpur A, Zheng Y, Zheng W, Chen Z, Lu W, Shu XO.
From the
1Department of Medicine, Vanderbilt Epidemiology Center,
Vanderbilt-Ingram Cancer Center, Vanderbilt
University School of Medicine, Nashville, TN; and 2Shanghai Institute of
Preventive Medicine,Shanghai, China.
OBJECTIVE:: The aim of this study was to estimate the prevalence of
menopausal symptoms in relation to treatment modalities in Asian women treated
for breast cancer. METHODS:: A population-based cohort
of 5,023 Chinese women aged 25 to 70 years with primary stage 0 to III breast
cancer was identified from a population-based tumor
registry and enrolled in the study approximately 6 months after diagnosis.
Participants were asked about the occurrence of specific menopausal symptoms.
Associations between these symptoms and breast cancer treatments were evaluated
by stratified, multivariate logistic regression. RESULTS::
Among women with a recent diagnosis of breast cancer, 67.2% of premenopausal
women and 46.3% of postmenopausal women experienced at least one menopausal
symptom, namely, hot flashes, night sweats, and/or vaginal dryness. Symptom
prevalence among postmenopausal women decreased progressively with age at
diagnosis (63.3% for women aged 51-55 y, 51.5% for women aged 56-60 y, and
34.4% for women aged >65 y; P < 0.01). Overall, the highest prevalence of
most symptoms occurred in women aged 46 to 55 years (P < 0.01). Chemotherapy
was positively associated with the occurrence of any symptom and with each
individual symptom, mainly in premenopausal women (adjusted odds ratio [OR] range,
2.2-3.3; P < 0.05 for all). Tamoxifen use and
immunotherapy were associated with having any symptom and with each individual
symptom, regardless of menopause status (adjusted OR range, 1.5-1.8 and
1.3-1.5, respectively; P < 0.05 for all). Women treated before menopause
were at particularly high risk of experiencing two or more symptoms after
chemotherapy (OR, 1.77; 95% CI, 1.54-4.98; Pinteraction
= 0.05) compared with postmenopausal women. CONCLUSIONS::
Menopausal symptoms are prevalent among Chinese women recently treated for
primary breast cancer. These symptoms are associated with age and menopause
status at the time of diagnosis, as well as with the type of treatment
received.
Semana del 22 al 28 de Julio de 2009
Diabetologia. 2009 Jul 23. [Epub ahead of print]
Menopausal hormone therapy
and new-onset diabetes in the
French Etude Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale (E3N) cohort.
de Lauzon-Guillain B, Fournier A, Fabre A, Simon N, Mesrine S, Boutron-Ruault MC, Balkau B, Clavel-Chapelon F. INSERM, ERI 20, EA 4045, Villejuif cedex,
France.
AIMS/HYPOTHESIS:
Two US randomised trials found a lower incidence of
type 2 diabetes in women treated by menopausal hormone therapy (MHT) with oral
conjugated equine oestrogen combined with medroxyprogesterone acetate. The purpose of
this study was to evaluate the influence of various MHTs, according to their
formulation and route of administration, on new-onset diabetes in a cohort of
postmenopausal French women. METHODS: The association between MHT use and
new-onset diabetes was investigated by Cox regression analysis in 63,624
postmenopausal women in the prospective French cohort of the Etude Epidemiologique de Femmes de la Mutuelle
Générale de l'Education Nationale (E3N). Cases of diabetes were identified through
self-reporting or drug-reimbursement record linkage, and further validated.
RESULTS: 1,220 new-onset diabetes cases were validated. We observed a lower
risk of new-onset diabetes among women who had ever used MHT (HR 0.82 [95% CI
0.72-0.93]), compared with those who had never used MHT. Adjustment for BMI
during follow-up (rather than according to baseline BMI) did not substantially
modify this association. An oral route of oestrogen administration was associated
with a greater decrease in diabetes risk than a cutaneous
route (HR 0.68 [95% CI 0.55-0.85] vs 0.87 [95% CI
0.75-1.00], p for homogeneity = 0.028). We were not able to show significant
differences between the progestagens used in combined
MHT. CONCLUSIONS/INTERPRETATION: Use of MHT appeared to be associated with a
lower risk of new-onset diabetes. This relationship was not mediated by changes
in BMI. Further studies are needed to confirm the stronger effect of oral
administration of oestrogen compared with cutaneous
administration.
J Clin Pharmacol. 2009
Jul 23. [Epub ahead of print]
Steady-State Pharmacokinetics Following Application of a Novel Transdermal Estradiol Spray in
Healthy Postmenopausal Women.
Morton TL, Gattermeir DJ, Petersen
CA, Day WW, Schumacher
RJ.
KV Pharmaceutical
Company.
This study was designed
to evaluate the steady-state pharmacokinetics (PK) of estradiol
and its metabolites, estrone and estrone
sulfate, following application of a novel estradiol transdermal spray to
healthy postmenopausal women. Participants were randomly assigned in parallel
to receive 1-, 2-, or 3-spray doses (24 participants/dose level) of a 1.7% estradiol metered-dose transdermal
spray (1.53 mg/spray) once daily for 14 days. Blood was collected predose on days 1 to 14 and over 7 days after the last
dose. Serum concentrations for all 3 analytes reached
steady state by day 7 or 8 and were still slightly above baseline on day 21. Estradiol, estrone, and estrone sulfate serum
concentrations generally increased with increasing dose. Mean estradiol and estrone maximum serum
concentration (Cmax) following 1, 2, or 3 sprays for
14 days were 36 and 50, 57 and 60, and 54 and 71 pg/mL,
respectively. Estradiol time when maximum
concentration occurred (tmax) was 18 to 20 hours. The
area under the serum concentration-time curve over 24 hours following the last
dose of study drug (AUC0-24 h) on day 14 for the 1-, 2-, and 3-spray groups,
respectively, was 471, 736, and 742 pgh/mL for estradiol; 886, 1208, and
1367 pgh/mL for estrone; and 16 501, 26 515, and 27 971 pgh/mL for estrone sulfate. The metered-dose estradiol
transdermal spray delivers estradiol
at therapeutic levels and produces low serum estrone
concentrations.
Menopause. 2009
Jul 21. [Epub ahead of print]
Age-related pelvic floor modifications and prolapse
risk factors in postmenopausal women.
Tinelli A, Malvasi A, Rahimi S, Negro R, Vergara D, Martignago R, Pellegrino M, Cavallotti C.
Department
of Obstetrics and Gynaecology, Vito Fazzi Hospital, Leece; Rome, Italy.
OBJECTIVE:: Genital prolapse is frequent in
postmenopausal women; it describes the loss of support to the pelvic organs,
resulting in a herniation of these into the vaginal
channel. This problem affects 50% of parous women,
and at least 50% of all women develop a mild form of genital prolapse after pregnancy. METHODS::
An extensive literature review from 1990 to 2008 was performed on prolapse etiology and its risk
factors; analyzing the data, we reviewed the genetic and biological aspects,
age-related prolapse, biological tissue
modifications, surgical problems, pelvic musculature modifications, and
neuropathy. RESULTS:: Data suggested that aging,
pelvic trauma, and surgery evoke tissue denervation
and devascularization, anatomic alterations, and
increased degradation of collagen; all of these may lead to a decrease in
mechanical strength and predispose an individual to prolapse.
It has been demonstrated that there is a reduction in protein content and
estrogens in uterosacral ligaments, in the vagina,
and in the parametrium of women with prolapse. This is a possible explanation for why many
surgical procedures to correct prolapse fail and
recurrences after surgical correction are frequent. CONCLUSIONS:: Even if the etiology of pelvic prolapse is poorly defined and multifactorial,
aging risk factors, such as biomechanical abnormalities in connective tissue
composition, hormonal deficiency, and irregular tissue metabolism, are nonmodifiable and therefore largely stated in clinical
practice. Regardless of future developments, based on the reported findings, prolapse therapy will be more influenced by genetics,
biological pelvic changes, changes in tissue homeostasis, and topical hormones,
rather than general pelvic corrective surgical anatomy.
Endocrinol Nutr. 2009 May;56(5):227-32. Epub 2009 Jul 1.
Lifestyle, socioeconomic status and
morbidity in postmenopausal women with grade II and III obesity.
Navarro
Rodríguez MC, Saavedra Santana
P, de Pablos Velasco P, Sablón González
N, et al.
Universidad de
Las Palmas de Gran Canaria. Las Palmas. Espańa.
BACKGROUND:
Obesity has become a major public health problem in all western countries, and
its prevalence is increasing. This condition is associated with a higher
prevalence of diabetes mellitus, hypertension, and coronary heart disease;
furthermore, obesity is a risk factor for mortality. OBJECTIVE: To study the
association of some prevalent diseases (diabetes mellitus, thyroid disease,
obesity, hypertension, inflammatory rheumatic disease, urolithiasis),
the distribution of some lifestyle factors (tobacco, alcohol and caffeine
consumption and physical activity during leisure time) and the prevalence of
poverty in a population of postmenopausal women in the Canary Islands with
obesity class II or III (BMI>35). METHOD: A personal interview was performed
in all patients. A questionnaire was administered to assess their lifestyles
and current medication use. The women's medical records were reviewed to
confirm the existence of certain diseases. A complete physical examination was
performed in all patients. Weight and height were measured with the patient
dressed in light clothing. Blood samples were obtained with the patient in a
fasting state for subsequent analysis. Poverty was defined according to the
criteria of the Spanish National Institute of Statistics. RESULTS: Women with
obesity class II or III were older (56.8 +/- 11 vs
53.9 +/- 11.6 years, p=0.02), shorter (153.7 +/- 6.3 vs
156.9 +/- 36.1 cm, p=0.001), heavier (89.6 +/- 9.3 vs
66.6 +/- 10.4 kg, p=0.001) and had a greater body surface than controls (1.73
+/- 0.13 vs 1.54 +/- 0.13 m2, p=0.001). Alcohol and
tobacco consumption were lower in obese women than in controls. Obese women
drank more coffee and took less physical activity during leisure time than
controls. The prevalence of hypertension -36% vs
17.9%, p=0.001, odds ratio [OR] [95% confidence interval (IC)]=2.57
(1.56-4.24)-, diabetes mellitus -24.4% vs 11.3%,
p=0.001, OR=2.52 (1.47-1.05)-and hypothyroidism -14.3% vs
8%, p=0.04; OR=1.91 (0.99-3.68)-was higher in obese women than in controls.
More than half lived in rural areas and were below the poverty threshold.
CONCLUSIONS: More than half of postmenopausal women with obesity class II or
III were below the poverty threshold and lived in a rural area. In these women
there was a lower consumption of alcohol and tobacco, lesser physical activity
during leisure time, and a higher prevalence of diabetes mellitus, hypertension
and hypothyroidism than in control postmenopausal women.
J Sex Med. 2009 Jul 13. [Epub ahead of print]
Vaginal Dryness: A Comparison of Prevalence and Interventions in 11
Countries.
Leiblum SR, Hayes RD, Wanser RA, Nelson JS.
New
Jersey Center for Sexual Wellness, Bedminister, NJ, USA.
ABSTRACT
Introduction. There is limited research comparing cross-cultural
differences in women's experiences of vaginal dryness. Aim.
To examine international differences in the prevalence of
vaginal dryness, the degree to which it is experienced as problematic or
bothersome, the use of lubricants to alleviate it, and women's discussion of
this problem with physicians. Main Outcome Measures.
Questionnaire measuring the level of vaginal dryness and
degree to which it is perceived as bothersome. Methods.
The Global Survey of Sexual Attitudes and Practices was administered to 6,725
women from 11 countries: UK, Germany, Japan, Australia, Canada, Spain, Italy,
Mexico, Argentina, Brazil and Thailand. Results.
Prevalence of self-reported vaginal dryness varied from a minimum of 5.8% in
Italy to a maximum of 19.7% in Brazil. The proportion of women with
self-reported vaginal dryness who found it very bothersome varied as well
(e.g., 5.6% UK, 26.4% Germany). Pain during intercourse ranged from a reported
low of 3.6% in Australia to 18.6% in Brazil. Older women (50-65 years) as
compared with younger women (18-34 years) reported significantly more vaginal
dryness in the UK, Australia, Canada, Italy, Spain, Argentina, and Thailand (P
values <0.02). The majority of women under 50 attributed vaginal dryness to
inadequate sexual arousal while women over 50 believed it was because of aging
or menopause. Cross-culturally, women differed substantially in the likelihood
of discussing their sexual life/concerns with a physician. Conclusion.
Women from different countries differ substantially in their experiences,
concerns, and reports of vaginal dryness/sexual pain, as well as their
familiarity with personal lubricants as a treatment. Researchers should assess
the prevalence and degree of the bother of vaginal dryness in order to make
international comparisons of the burden of this condition.
Am J Clin Nutr. 2009 Jul 22. [Epub ahead of print]
Dietary fiber intake and risk of breast cancer
in postmenopausal women: the National Institutes of Health-AARP Diet and Health
Study.
Park Y, Brinton LA, Subar AF, Hollenbeck
A, Schatzkin A.
National Cancer
Institute, Bethesda, MD, and the AARP, Washington, DC.
BACKGROUND: Although
dietary fiber has been hypothesized to lower risk of
breast cancer by modulating estrogen metabolism, the
association between dietary fiber intake and risk of
breast cancer by hormone receptor status is unclear. OBJECTIVE: The objective
was to examine the relation of dietary fiber intake
to breast cancer by hormone receptor status and histologic
type among postmenopausal women in the National Institutes of Health-AARP Diet
and Health Study (n = 185,598; mean age: 62 y). DESIGN: Dietary intakes were
assessed with a food-frequency questionnaire. Incident breast cancer cases were
identified through linkage with state cancer registries. Cox proportional
hazard models were used to estimate relative risks (RRs) and 2-sided 95% CIs.
RESULTS: During an average of 7 y of follow-up, 5461 breast cancer cases were
identified, of which 3341 cases had estrogen receptor
(ER) and progesterone receptor (PR) status. Dietary fiber
intake was inversely associated with breast cancer risk [RR for the highest
quintile (Q5) compared with the lowest quintile (Q1): 0.87; 95% CI: 0.77, 0.98;
P for trend: 0.02]. The inverse association appeared to be stronger for ER(-)/PR(-) tumors (RR(Q5vsQ1):
0.56; 95% CI: 0.35, 0.90; P for trend: 0.008; 366 cases) than that for
ER(+)/PR(+) tumors (RR(Q5vsQ1): 0.95; 95% CI: 0.76,
1.20; P for trend: 0.47; 1641 cases). The RR(Q5vsQ1)
of lobular tumors was 0.66 (95% CI: 0.44, 0.97; P for
trend: 0.04) and 0.90 (95% CI: 0.77, 1.04; P for trend: 0.10) for ductal tumors. Fiber from grains, fruit, vegetables, and beans was not
related to breast cancer. CONCLUSION: Our findings suggest that dietary fiber can play a role in preventing breast cancer through nonestrogen pathways among postmenopausal women.
Rev Med Chil. 2009 Mar;137(3):345-50. Epub 2009 Jun
15.
Prevalence of sexual dysfunction among climacteric women
Figueroa J R, Jara A D, Fuenzalida P A, Del Prado A M, Flores D, Blumel JE.
Departamento de Gineco-obstetricia,
Escuela de Medicina, Universidad Diego Portales, Santiago, Chile. BACKGROUND:
The Female Sexual Function index (FSFI), is a scale designed to evaluate
sexuality and diagnose the presence of sexual dysfunction in women. AIM: To
apply the FSFI to climacteric women. PATIENTS AND METHODS: The FSFI was applied
to 370 healthy women aged between 40 and 59years old (49 +/- 6years) that
accompanied patients to public health services in